| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,012 |
2,942 |
$81K |
| D1110 |
Prophylaxis - adult |
1,537 |
1,500 |
$78K |
| D1120 |
Prophylaxis - child |
1,585 |
1,549 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,657 |
1,619 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
538 |
276 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,036 |
2,970 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,687 |
2,615 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,641 |
2,478 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
347 |
188 |
$22K |
| D0272 |
Bitewings - two radiographic images |
812 |
795 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
219 |
211 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
37 |
$3K |
| D1351 |
Sealant - per tooth |
70 |
16 |
$2K |
| D0350 |
|
198 |
147 |
$2K |
| D0330 |
Panoramic radiographic image |
60 |
59 |
$1K |
| D0603 |
|
1,747 |
1,724 |
$0.00 |
| D0602 |
|
828 |
814 |
$0.00 |
| D0601 |
|
273 |
251 |
$0.00 |